Revue du rhumatisme (English ed.)
-
Appropriate attention can be directed to quality of life indices in the evaluation of therapeutic interventions only if reliable, valid measurement tools with good sensitivity to change are available. The goal of this study was to validate the French version of the Arthritis Impact Measurement Scales 2 (AIMS2), called EMIR (Echelle de Mesure de l'Impact de la polyarthrite Rhumatoïde) and to compare it with the validated French version of the Nottingham Health Profile, called ISPN (Indicateur de Santé Perceptuelle de Nottingham). The French version of the AIMS2 (37 items, 12 dimensions) was obtained via several independent translations and back-translations, followed by selection of the most relevant items by a panel of experts and a preliminary evaluation in rheumatoid arthritis patients. ⋯ Sensitivity to change after three and six months was significant for 11 of the 12 dimensions (mean standardized responses, 0.30 to 0.77). Sensitivity to change was slightly better for the EMIR than for the ISPN. Analysis of scores demonstrated that these two instruments did not measure quality of life in exactly the same way but complemented each other.
-
A 70-year-old man with prostatic cancer extending to the urinary bladder underwent transurethral resection of the bladder neck under spinal anesthesia and developed weakness of the proximal lower limbs a few hours after the procedure. The weakness persisted for several months. ⋯ Neurologic deficits are uncommon after spinal anesthesia and can be produced by complications of the surgical procedure (direct nerve injury, hematoma, abscess), arachnoiditis, neurotoxicity of disinfectants or of preservatives added to solutions of anesthetic drugs, or spinal cord ischemia. Precipitating factors for spinal cord ischemia include faulty patient position during the procedure, intraoperative arterial hypotension and injection of vasoconstricting agents.
-
Both mechanical and biochemical factors are involved in the pathophysiology of nerve root compression. Chronic compression produces severe demyelination and fibrosis of the nerve root. Similar lesions can result from exposure to irritant substances released from the nucleus pulposus. ⋯ Algogenic substances are released that lower the activation threshold of nociceptors, producing peripheral sensitization. In the central nervous system, neuroplasticity and increased transmission of nociceptive signals in the spinal cord result in permanent excitation and sensitization of the spinal convergent neurones. The practical implications of these data are discussed.
-
Randomized Controlled Trial Clinical Trial
Forceful epidural injections for the treatment of lumbosciatic pain with post-operative lumbar spinal fibrosis.
To evaluate the efficacy of forceful epidural corticosteroid injections in lumbosciatic pain ascribed to post-operative lumbar spinal fibrosis. ⋯ Although mediocre overall, the results of forceful epidural corticosteroid injections are better than those of simple epidural injections of a corticosteroid alone. Given the paucity of effective treatments for lumbosciatic pain apparently due to postoperative fibrosis, forceful injections should be given a place in the treatment of this condition.
-
A case of destructive vertebral and discal lesions in a patient with chronic, noninfected rupture of an abdominal aortic aneurysm is reported. The main rheumatic manifestations of abdominal aortic aneurysms are reviewed. Perianeurysmal inflammation may contribute to the development of destructive vertebral and discal lesions.